JAK inhibitors in autoimmune ocular inflammatory diseases – A systematic review of case reports and series

BACKGROUND: Autoimmune inflammatory ocular diseases, including uveitis, scleritis, and ocular mucous membrane pemphigoid, can cause severe, vision-threatening complications and are often associated with systemic autoimmune conditions. Standard therapies involve corticosteroids, conventional disease-modifying antirheumatic drugs (cDMARDs), and biologics, yet some cases remain refractory. Janus kinase (JAK) inhibitors have emerged as a promising therapeutic option for such refractory cases and are increasingly being explored as potential primary or secondary line therapies. MAIN BODY: This systematic review synthesized evidence from case reports and case series describing the use of JAK inhibitors in non-infectious ocular inflammation. A comprehensive search of PubMed and MEDLINE (from inception to March 2025) identified 22 studies (12 case reports, 10 case series) involving 43 patients (64 eyes). Patients ranged from 13 to 85 years (mean = 41) with a female predominance (69.7%). Reported ocular conditions included scleritis (46.5%), uveitis (34.9%), ocular mucous membrane pemphigoid (7.0%), keratitis (4.7%), keratoconjunctivitis (4.7%), and non-specific orbital inflammation (2.3%). Most patients had failed prior therapies with corticosteroids, cDMARDs (80%), and biologics (51%) before initiating JAK inhibitors. Tofacitinib (62.8%) was the most frequently used agent. The median follow-up was approximately 2.5 months (range: 1-78 months). Complete remission was achieved in 69.7% of patients, while 27.9% experienced partial or marked improvement. More than half of the patients were able to taper or discontinue corticosteroids. No relapses were reported during follow-up. Reported adverse events were mild and included elevated transaminases, leukopenia, neutropenia, and herpes virus reactivation. CONCLUSION: JAK inhibitors demonstrate promising efficacy and an acceptable safety profile in refractory autoimmune ocular inflammatory diseases, enabling high rates of remission and reduced steroid dependence. These findings highlight their potential role in treatment algorithms and underscore the need for further prospective studies to define their long-term efficacy, safety, and optimal use.